Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr 5;2(4):e191691.
doi: 10.1001/jamanetworkopen.2019.1691.

Epidemiologic Trends in Malaria Incidence Among Travelers Returning to Metropolitan France, 1996-2016

Eric Kendjo  1 , Sandrine Houzé  2 , Oussama Mouri  3 , Aida Taieb  4 , Frédérick Gay  1 , Stéphane Jauréguiberry  1 , Ilhame Tantaoui  1 , Papa A Ndour  5 , Pierre Buffet  5 , Martine Piarroux  6 , Marc Thellier  1 , Renaud Piarroux  1 ; French Imported Malaria Study Group
Affiliations

Epidemiologic Trends in Malaria Incidence Among Travelers Returning to Metropolitan France, 1996-2016

Eric Kendjo et al. JAMA Netw Open. .

Abstract

Importance: Despite annually adapted recommendations to prevent malaria in travelers to endemic areas, France is still the industrialized country reporting the highest number of imported cases of malaria. Better understanding of the epidemiologic context and evolution during the past 2 decades may help to define a better preventive strategy.

Objective: To study epidemiologic trends of imported cases of malaria in travelers in geographic territories of France on the European continent (metropolitan France) from 1996 through 2016 to potentially explain the persistence of high imported malaria incidence despite national preventive measures.

Design, setting, and participants: In a cross-sectional study, between January 1 and May 31, 2018, data were extracted from the French National Reference Center of Malaria Surveillance. Trends in patients with imported malaria in association with age, sex, ethnicity, purpose of travel, malaria species, severity of illness, case mortality rate, and endemic countries visited were analyzed in 43 333 malaria cases among civilian travelers living in metropolitan France.

Main outcomes and measures: Evolution of the main epidemiologic characteristics of patients with imported malaria.

Results: Among the 43 333 patients with imported malaria in civilian travelers included in the study, 24 949 were male (62.4%), and 8549 were younger than 18 years (19.9%). A total of 28 658 malaria cases (71.5%) were among African individuals, and 10 618 cases (26.5%) among European individuals. From 1996 through 2016, the number of confirmed malaria cases peaked at 3400 cases in 2000, then declined to 1824 cases in 2005 and stabilized thereafter to approximately 1720 malaria cases per year. A total of 37 065 cases (85.5%) were due to Plasmodium falciparum. The proportion of malaria cases among African individuals rose from 53.5% in 1996 to 83.4% in 2016, and the most frequent motivation for traveling was visiting friends and relatives (25 329 [77.1%]; P < .001). Despite an increase in the proportion of severe cases, which rose from 131 cases (8.9%) in 1996 to 279 cases (16.7%) in 2016 (P < .001), mortality remained stable, being approximately 0.4% during the study period.

Conclusions and relevance: Beyond the apparent stability of the number of imported malaria cases in France, significant changes appear to have occurred among the population who developed malaria infection following travel in endemic areas. These changes may imply that adaptation of the preventive strategy is needed to reduce the burden of the disease among travelers.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Drs Houzé and Thellier reported grants from Santé Publique France during the conduct of the study. Drs Buffet, Jauréguiberry, Ndour, and Thellier reported grants from Guilin Pharmaceuticals during the conduct of the study. Dr Jauréguiberry also reported grants from Walter Reed Army Institute of Research during the conduct of the study. Dr Ndour also reported grants from Institut National de la Santé et de la Recherche Médicale during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Imported Malaria in Civilian Travelers, Metropolitan France, 1996-2016
Malaria cases were identified through the Centre National de Référence du Paludisme.
Figure 2.
Figure 2.. Imported Malaria Cases In Civilian Travelers, Metropolitan France, 1996-2016
Observed and estimated cases.
Figure 3.
Figure 3.. Civilian Travelers With Imported Malaria in Metropolitan France, 1996-2016
A, Evolution of the proportion of African vs European travelers by year (n = 39 276). B, Median age (n = 42 971); error bars indicate interquartile range. C, Distribution of age by sex (n = 42 905).
Figure 4.
Figure 4.. Severity and Mortality in Civilian Travelers With Imported Malaria in Metropolitan France, 1996-2016
A, Severe imported malaria cases (n = 5158). B, Case-fatality rates (n = 166).
See this image and copyright information in PMC

References

    1. Tatem AJ, Jia P, Ordanovich D, et al. . The geography of imported malaria to non-endemic countries: a meta-analysis of nationally reported statistics. Lancet Infect Dis. 2017;17(1):-. doi:10.1016/S1473-3099(16)30326-7 - DOI - PMC - PubMed
    1. CNR Rapport annuel d’activité. https://ssl.voozanoo.net/palu/. Accessed March 27, 2018.
    1. Legros F, Fromage M, Ancelle T, et al. . Enquête nationale de recensement des cas de Paludisme d’importation en France métropolitaine pour l’année 1997. Bulletin Epidémiologique Hebdomadaire. 1999;1999(11):41-42.
    1. Management and prevention of imported Plasmodium falciparum malaria. The 12th Consensus Conference of Anti-infectious Therapy of the French-speaking Society of Infectious Diseases, 14 April 1999 [in French]. Arch Pediatr. 2000;7(2):201-208. - PubMed
    1. Société de Pathologie Infectieuse de Langue Française; Collège des Universitaires de Maladies Infectieuses et Tropicales; Société Française de Médecine des Armées; Société Française de Parasitologie; Société Française de Pédiatrie; Société de Médecine des Voyages; Société de Pathologie Exotique; Société de Réanimation de Langue Française . Management and prevention of imported Plasmodium falciparum malaria (revision 2007 of the 1999 Consensus Conference) [in French].Med Mal Infect. 2008;38(2):68-117. - PubMed

Publication types

MeSH terms